1 SECOND AMENDMENT TO THE AGREEMENT FOR CONSULTING SERVICES
BETWEEN THE CITY OF REDONDO BEACH
AND LUCCI & ASSOCIATES, INC.
THIS SECOND AMENDMENT TO THE AGREEMENT FOR CONSULTING SERVICES (“Second Amendment”) is made between the City of Redondo Beach, a chartered municipal corporation (“City”) and Lucci & Associates, a California corporation (“Contractor” or “Consultant”).
WHEREAS, on May 5, 2020, the parties entered into the Agreement for Consulting Services between the City and Consultant (the "Agreement"); and
WHEREAS, on May 3, 2022, the parties entered into the First Amendment to the Agreement to extend the term and raise the Contractor’s compensation limit (the "First Amendment"); and
WHEREAS, the parties desire to amend the Agreement.
NOW THEREFORE, in consideration of the promises and mutual covenants contained herein, and intending to be legally bound, the parties hereby agree to make the following amendments to the Agreement:
1. TERM AND TIME OF COMPLETION. Exhibit “B” and Exhibit “B-1” of the Agreement are hereby amended to add Exhibit “B-2”, which extends the Agreement to May 5, 2026. Exhibit “B-2” is attached hereto and incorporated by reference. Consultant shall commence and complete all services described in Exhibit “A” in accordance with the schedule set forth in Exhibit “B-2”.
2. COMPENSATION. Exhibit “C” and Exhibit “C-1” of the Agreement are hereby amended to add Exhibit “C-2” to increase Consultant’s hourly rates and total compensation limit to $300,000. Exhibit “C-2” is attached hereto and incorporated by reference. Consultant shall be compensated for the services described in Exhibit “A” of the Agreement.
3. INSURANCE. Exhibit “D” of the Agreement is hereby amended to add Exhibit “D-1” to raise the Consultant’s general liability coverage from $1 million to $2 million dollars.
Exhibit “D-1” is attached hereto and incorporated by reference. Consultant shall comply with the insurance requirements in Exhibit “D-1”
4. NO OTHER AMENDMENTS. Except as expressly stated herein, the Agreement shall remain unchanged and in full force and effect. The Agreement, First Amendment, and this Second Amendment constitute the entire agreement between the parties and supersede any previous oral or written agreement with respect to the subject matter hereof. In the event of any inconsistency between the terms of the Agreement, First Amendment, and this Second Amendment, the terms of this Second Amendment shall govern.
2 IN WITNESS WHEREOF, the parties have executed this Second Amendment in Redondo Beach, California, as of this 16th day of April, 2024.
CITY OF REDONDO BEACH, LUCCI & ASSOCIATES, INC.,
a chartered municipal corporation a California corporation By:
James Light, Mayor Name: Kenneth Lucci
Title: President
ATTEST: APPROVED:
Eleanor Manzano, City Clerk Diane Strickfaden, Risk Manager APPROVED AS TO FORM:
Michael W. Webb, City Attorney
3 EXHIBIT “B-2”
SCHEDULE FOR COMPLETION
TERM. The term of this Agreement shall be extended to May 5, 2026 (“Term”), unless otherwise terminated as herein provided.
4 EXHIBIT “C-2”
COMPENSATION
Provided Consultant is not in default under this Agreement, Consultant shall be compensated as provided below.
I. AMOUNT. Effective April 16, 2024, Consultant shall perform the work for all City approved Task Proposal(s) in accordance with the attached hourly rate schedule, which is hereby incorporated.
II. EXPENSES. Consultant shall be reimbursed for expenses in accordance with the attached schedule. If Consultant requires reimbursement for expenses not provided on the attached schedule, including but not limited to, mileage, reproduction costs, and subcontractor markup, Consultant shall not be reimbursed without a subsequent written amendment, which shall be at the sole discretion of the city.
III. NOT TO EXCEED AMOUNT. In no event shall the total amount paid to the Consultant, including reimbursable expenses, exceed $300,000 during the term of this Agreement.
IV. METHOD OF PAYMENT. Consultant shall provide monthly invoices to City for approval and payment for those services performed in the month prior to invoice submission. Invoices must include the following information.
A. Task number.
B. All personnel who performed work on the Task.
C. Description of the work performed.
D. Number of hours worked.
E. Hourly rate.
F. All city approved and documented subcontractor invoices.
G. If applicable, expenses incurred.
Invoice must be itemized, adequately detailed, based on accurate records, in a form reasonably satisfactory to the city. Invoices must attach the prior written authorization of the City and copies of receipts to substantiate expense requests. Consultant may be required to provide back-up material upon request. If no work is performed in a given month, no invoice is required.
Within the approved amount of each approved Task Proposal, and with the written approval of the city, a portion of the amount from the line item of the task may be allocated to another line item task so long as the total amount approved for the Task Proposal as described in Exhibit “A” in not exceeded.
V. SCHEDULE FOR PAYMENT. City agrees to pay Consultant within thirty (30) days after receipt of Consultant’s monthly invoice; provided, however, that services are completed to the City’s reasonable satisfaction and there is no dispute over the amount.
VI. NOTICE. Written notices to City and Consultant shall be given by registered or 5 certified mail, postage prepaid and addressed to or personally served on the following parties.
Consultant: Lucci & Associates, Inc.
3251 Corte Malpaso #511
Camarillo, CA 93012-8094
Attn: Ken Lucci
City City of Redondo Beach
Public Works Department, Engineering Services Division
415 Diamond Street
Redondo Beach, CA 90277
Attn: City Engineer
All notices, including notices of address changes, provided under this Agreement are deemed received on the third day after mailing if sent by registered or certified mail. Changes in the respective address set forth above may be made from time to time by any party upon written notice to the other party.
BASIC FEE SCHEDULE
Consulting Electrical Engineers – Services
Effective 1/1/24
Classification Hourly Rate
Principal.................................................................$240.00 Project Manager.....................................................$215.00 Project Engineer.....................................................$200.00 Design Engineer.....................................................$185.00 Drafter ....................................................................$140.00 Word/Data Processing...........................................$115.00 6 EXHIBIT “D-1”
INSURANCE REQUIREMENTS FOR CONSULTANTS
Without limiting Consultant's indemnification obligations under this Agreement, Consultant shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the Consultant, its agents, representatives, or employees.
Minimum Scope of Insurance
Coverage shall be at least as broad as:
Insurance Services Office Commercial General Liability coverage (occurrence form CG 0001).
Insurance Services Office form number CA 0001 (Ed. 1/87) covering Automobile Liability, code 1 (any auto).
Workers' Compensation insurance as required by the State of California.
Employer's Liability Insurance.
Errors and Omissions liability insurance appropriate to the consultant's profession.
Architects' and Engineers' coverage is to be endorsed to include contractual liability.
Minimum Limits of Insurance
Consultant shall maintain limits no less than:
General Liability: $2,000,000 per occurrence for bodily injury, personal injury and property damage. The general aggregate limit shall apply separately to this project/location.
Automobile Liability: $1,000,000 per accident for bodily injury and property damage.
Employer's Liability: $1,000,000 per accident for bodily injury or disease.
Errors and Omissions liability: $1,000,000 per occurrence.
Deductibles and Self-Insured Retentions
Any deductibles or self-insured retentions must be declared to and approved by the City. At the option of the City, either: (1) the insurer shall reduce or eliminate such deductibles or self-insured retentions as respects the City, its officers, officials, employees and volunteers or (2) the Consultant shall provide a financial guarantee satisfactory to the City guaranteeing payment of losses and related investigations, claim administration and defense expenses.
7 Other Insurance Provisions
The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions:
Additional Insured Endorsement:
General Liability: The City, its officers, elected and appointed officials, employees, and volunteers are to be covered as insureds with respect to liability arising out of work performed by or on behalf of the Consultant. General liability coverage can be provided in the form of an endorsement to the Consultant's insurance, or as a separate owner's policy.
Automobile Liability: The City, its officers, elected and appointed officials, employees, and volunteers are to be covered as insureds with respect to liability arising out of automobiles owned, leased, hired or borrowed by or on behalf of the Consultant.
For any claims related to this project, the Consultant's insurance coverage shall be primary insurance as respects the City, its officers, elected and appointed officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the Consultant's insurance and shall not contribute with it.
Each insurance policy required by this clause shall be endorsed to state that coverage shall not be canceled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City.
Each insurance policy shall be endorsed to state that the inclusion of more than one insured shall not operate to impair the rights of one insured against another insured, and the coverages afforded shall apply as though separate policies had been issued to each insured.
Errors and Omissions policy, if written on a claims made basis, shall be maintained by the Consultant for a period of one year after the completion of the project.
Each insurance policy shall be in effect prior to awarding the contract and each insurance policy or a successor policy shall be in effect for the duration of the project. The maintenance of proper insurance coverage is a material element of the contract and failure to maintain or renew coverage or to provide evidence of renewal may be treated by the City as a material breach of contract on the Consultant's part.
Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best's rating of no less than A:VII and which are authorized to transact insurance business in the State of California by the Department of Insurance.
8 Verification of Coverage
Consultant shall furnish the City with original certificates and amendatory endorsements effecting coverage required by this clause. The endorsements should be on the City authorized forms provided with the contract specifications. Standard ISO forms which shall be subject to City approval and amended to conform to the City's requirements may be acceptable in lieu of City authorized forms. All certificates and endorsements are to be received and approved by the City before the contract is awarded. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications at any time.
Subcontractors
Consultant shall include all subcontractors as insured under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements stated herein.
Risk Management
Consultant acknowledges that insurance underwriting standards and practices are subject to change, and the City reserves the right to make changes to these provisions in the reasonable discretion of its Risk Manager.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A : NAIC #
NAME: CONTACT
(A/C, No): FAX
E-MAIL ADDRESS:
PRODUCER
(A/C, No, Ext): PHONE
INSURED
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR WVDADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $
$
$
$ PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person) COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEEE.L. EACH ACCIDENT EROTH- STATUTE PER
(MM/DD/YYYY) LIMITS POLICY EXP(MM/DD/YYYY) POLICY EFFLTR TYPE OF INSURANCE POLICY NUMBER INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $
$
OCCUR
CLAIMS-MADE DED RETENTION $
PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $
EACH OCCURRENCE $ DAMAGE TO RENTED
PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
1/11/2024
AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt. Diablo Blvd Suite 230
Lafayette CA 94549
Maurice Thornton 510-272-1476 [email protected] License#: 6003745 Travelers Property Casualty Company of America 25674 LUCC&AS-01 The Travelers Indemnity Company of Connecticut 25682 Lucci & Associates, Inc.
3251 Corte Malpaso, #511
Camarillo CA 93012
Travelers Casualty and Surety Co of America 31194 Hartford Casualty Insurance Company 29424 223107064 A X 2,000,000 X 1,000,000 X Contractual Liab 10,000 Included 2,000,000 4,000,000 X X Y Y 6806H320610 1/11/2024 1/11/2025
4,000,000
B 1,000,000 X XY Y BA3R587874 1/11/2024 1/11/2025
A X X 4,000,000 Y Y CUP9K023174 1/11/2024 1/11/2025
4,000,000 X
0 D Y 57WEGAB8WKG 1/31/2024 1/31/2025
X
1,000,000 1,000,000 1,000,000
C Professional Liability 107569705 1/31/2024 1/31/2026 Per Claim Aggregate Limit
$1,000,000
$2,000,000
Insured owns no company vehicles; therefore, hired/non-owned auto is the maximum coverage that applies. The Umbrella Policy is follow form to its underlying Policies: General Liability/Auto Liability/Employers Liability.
All Operations of the Named Insured The City of Redondo Beach, it's officers, elected and appointed officials, employees and volunteers are named as additional insureds as respects general and auto liability as required per written contract. General Liability is Primary/Non-Contributory per policy form wording.
Insurance coverage includes waiver of subrogation per the attached endorsement(s). SEE CANCELLATION SECTION of Certificate for 30 Days 30 Day Notice of Cancellation
City of Redondo Beach
Attn: Andrew Winje
415 Diamond Street
Redondo Beach CA 90277
COMMERCIAL GENERAL LIABILITY
c. Method Of Sharing
If all of the other insurance permits contribution
by equal shares, we will follow this method also.
Under this approach each insurer contributes
equal amounts until it has paid its applicable
limit of insurance or none of the loss remains,
whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will contribute
by limits. Under this methoo, each insurer's
share is based on the ratio of its applicable limit
of insurance to the total applicable limits of
insurance of all insurers.
d. Primary And Non-Contributory Insurance If
Required By Written Contract
If you specifically agree in a written contract or
agreement that the insurance afforded to an
insured under this Coverage Part must apply on
a primary basis, or a primary and noncontributory basis. this insurance is primary to other insurance that is available to such insured
which covers such insured as a named insured,
and we will not share with that other insurance,
provided that:
(1) The "bodily injury'' or "property damage" for
which coverage is sought occurs; and
(2) The "personal and advertising injury" for
which coverage is sought is caused by an
offense that is committed;
subsequent to the signing of that contract or
agreement by you.
5. Premium Audit
a. We will compute all premiums for this Coverage
Part in accordance with our rules and rates.
b. Premium shown in this Coverage Part as
advance premium is a deposit premium only. At
the close of each audit perioo we will compute
the earned premium for that period and send
notice to the first Named Insured. The due date
for audit and retrospective premiums is the date
shown as the due date on the bill. If the sum of
the advance and audit premiums paid for the
policy period is greater than the earned
premium, we will return the excess to the first
Named Insured.
c. The first Named Insured must keep records of
the information we need for premium
computation, and send us copies at such times
as we may request.
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are
accurate and complete;
b. Those statements are based upon
representations you made to us; and
c. We have issued this policy in reliance upon
your representations.
The unintentional omission of, or unintentional error
in, any information provided by you which we relied
upon in issuing this policy will not prejudice your
rights under this insurance. However, this provision
does not affect our right to collect additional
premium or to exercise our rights of cancellation or
nonrenewal in accordance with applicable insurance
laws or regulations.
7. Separation Of Insureds
Except with respect to the Limits of Insurance, and
any rights or duties specifically assigned in this
Coverage Part to the first Named Insured, this
insurance applies:
a. As if each Named Insured were the only
Named Insured; and
b. Separately to each insured against whom claim
is made or "suit" is brought.
8. Transfer Of Rights Of Recovery Against Others
To Us
If the insured has rights to recover all or part of any payment we have made under this Coverage Part,
those rights are transferred to us. The insured must
do nothing after loss to impair them. At our request,
the insured will bring "suit" or transfer those rights
to us and help us enforce them.
9. When We Do Not Renew
If we decide not to renew this Coverage Part, we will
mail or deliver to the first Named Insured shown in
the Declarations written notice of the nonrenewal
not less than 30 days before the expiration date.
If notice is mailed, proof of mailing will be sufficient proof of notice.
SECTION V - DEFINITIONS
1. "Advertisement" means a notice that is broadcast or
published to the general public or specific market
segments about your goods, products or services
for the purpose of attracting customers or
supporters. For the purposes of this definition:
a. Notices that are published include material
placed on the Internet or on similar electronic
means of communication; and
b. Regarding websites, only that part of a website
that is about your goods, prooucts or services
for the purposes of attracting customers or
supporters is considered an advertisement.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
Policy # 6806H320610
COMMERCIAL GENERAL LIABILITY
occupational therapist or occupational that is available to any of your "employees" therapy assistant, physical therapist or for "bodily injury" that arises out of providing speech-language pathologist; or or failing to provide "incidental medical services" to any person to the extent not (b) First aid or "Good Samaritan services" subject to Paragraph 2.a.(1) of Section II by any of your "employees" or "volunteer Who Is An Insured. workers", other than an employed or volunteer doctor. Any such "employees" K. MEDICAL PAYMENTS INCREASED LIMIT or "volunteer workers" providing or failing The following replaces Paragraph 7. of to provide first aid or "Good Samaritan SECTION III LIMITS OF INSURANCE: services" during their work hours for you will be deemed to be acting within the 7. Subject to Paragraph 5. above, the Medical scope of their employment by you or Expense Limit is the most we will pay under performing duties related to the conduct Coverage C for all medical expenses of your business. because of "bodily injury" sustained by any
3. The following replaces the last sentence of one person, and will be the higher of:
Paragraph 5. of SECTION III LIMITS OF a. $10,000; or
INSURANCE:
b. The amount shown in the Declarations of For the purposes of determining the this Coverage Part for Medical Expense
applicable Each Occurrence Limit, all related
Limit. acts or omissions committed in providing or
failing to provide "incidental medical L. AMENDMENT OF EXCESS INSURANCE services", first aid or "Good Samaritan CONDITION PROFESSIONAL LIABILITY services" to any one person will be deemed The following is added to Paragraph 4.b., to be one "occurrence".
Excess Insurance, of SECTION IV
4. The following exclusion is added to COMMERCIAL GENERAL LIABILITY Paragraph 2., Exclusions, of SECTION I CONDITIONS:
COVERAGES COVERAGE A BODILY
This insurance is excess over any of the other
INJURY AND PROPERTY DAMAGE
insurance, whether primary, excess, contingent LIABILITY:
or on any other basis, that is Professional Sale Of Pharmaceuticals Liability or similar coverage, to the extent the
"Bodily injury" or "property damage" arising loss is not subject to the professional services out of the violation of a penal statute or exclusion of Coverage A or Coverage B. ordinance relating to the sale of M. BLANKET WAIVER OF SUBROGATION pharmaceuticals committed by, or with the WHEN REQUIRED BY WRITTEN CONTRACT knowledge or consent of the insured. OR AGREEMENT
5. The following is added to the DEFINITIONS
Section: The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, "Incidental medical services" means: of SECTION IV COMMERCIAL GENERAL a. Medical, surgical, dental, laboratory, x- LIABILITY CONDITIONS:
ray or nursing service or treatment,
If the insured has agreed in a written contract or advice or instruction, or the related agreement to waive that insured's right of
furnishing of food or beverages; or
recovery against any person or organization, we b. The furnishing or dispensing of drugs or waive our right of recovery against such person medical, dental, or surgical supplies or or organization, but only for payments we make appliances. because of:
6. The following is added to Paragraph 4.b., a. "Bodily injury" or "property damage" that Excess Insurance, of SECTION IV occurs; or COMMERCIAL GENERAL LIABILITY
CONDITIONS: b. "Personal and advertising injury" caused by an offense that is committed; This insurance is excess over any valid and collectible other insurance, whether primary, subsequent to the signing of that contract or excess, contingent or on any other basis, agreement.
CG D3 79 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
Policy #
6806H320610
COMME A RCI L AUTO
THIS ENDORSEMENT CHANGES T EH POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
This n n o i s n e dorseme t m d fie i surance provi t o l w ded under he f l o ing:
BUSI S U C E O NE S A TO OV RAGE F RM
MO R R E E G O TO CA RI R COV RA E F RM
The fol w s lo ing i added to Paragraph c. in A.1., Who between you and that person or organization, that is Is An Insured, of SECTION II COV R T S E ED AU O sig u f r ned by yo be o e the "bodil " r y injury or "prope ty LI L T V R ABI I Y CO E AGE in the BUSINE O SS AUT dama " s ge occur and that is in eff ce t during the policy COVERAGE FORM and Paragraph e. in A.1., Who Is period, to name as an additional insured for e Cov red An Insured, of SECTION II COV T S ERED AU O Autos i e Liabil ty Cov rage, but on r a ly fo dam ges to LI L T V ABI I Y CO ERAGE in the MOTOR CARRIER which this insurance applies d an only to the ext f ent o COVERAGE FORM, whicheve v r Co erage Form is that person r r i n 's o o ganizat o 's liab i r n il ty fo the co duct par f o c : t o y ur poli y of h s anot er "in ured".
This n u s n z i cl de any perso or organi ation who you are req r r ui ed unde a written contr c r r m a t o ag ee ent CA T 0 4 37 2 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
Policy:
BA3R587874
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET WAIVER OF SUBROGATION
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
The following replaces Paragraph A.5., Transfer of required of you by a written contract executed Rights Of Recovery Against Others To Us, of the prior to any "accident" or "loss", provided that the CONDITIONS Section: "accident" or "loss" arises out of the operations
5. Transfer Of Rights Of Recovery Against Oth- contemplated by such contract. The waiver apers To Us plies only to the person or organization desigWe waive nated in such contract. any right of recovery we may have against any person or organization to the extent
CA T3 40 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
Policy #
BA3R587874
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Policy Expiration Date:
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: Endorsement Number:
Effective Date: Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address:
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.
The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us
57WEGAB8WKG 01/31/2024
Lucci & Associates, Inc.
3251 Corte Malpaso, #511
Camarillo, CA 93012
01/31/2025